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Citation
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Ham AC, van Dijk SC, Swart KMA, Enneman AW, van der Zwaluw NL, Brouwer-Brolsma EM, van Schoor NM, Carola Zillikens M, Lips P, de Groot LCPGM, Hofman A, Witkamp RF, Uitterlinden AG, Stricker BH, van der Velde N. Br. J. Clin. Pharmacol. 2017; 83(10): 2292-2302. |
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Affiliation
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Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, P.O. Box 22700, 1100, DD, Amsterdam, the Netherlands. |
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Abstract
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AIMS: To investigate the association between use of beta-blockers and beta-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA), and CYP2D6 enzyme metabolism - and fall risk.
METHODS: Data from two prospective studies were used, including community-dwelling individuals, N=7,662 (the Rotterdam Study) and 2,407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying beta-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between beta-blocker use, their characteristics - selectivity, lipid solubility, ISA, and CYP2D6 enzyme metabolism - , and fall risk. The results of the studies were combined using meta-analyses.
RESULTS: In total 2,917 participants encountered a fall during a total follow-up time of 89,529 years. Meta-analysis indicated no association between use of any beta-blocker, compared to non-use, and fall risk, HR=0.97 (95%CI 0.88; 1.06). Neither was use of a selective beta-blocker associated with fall risk, HR=0.92 (95%CI 0.83; 1.01). Use of a non-selective beta-blocker was associated with an increased fall risk, HR=1.22 (95%CI 1.01; 1.48). Other beta-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk.
CONCLUSION: Our study suggests that use of a non-selective beta-blocker, contrary to selective beta-blockers, is associated with an increased fall risk in an older population. In clinical practice, beta-blockers have been shown effective for a variety of cardiovascular indications. Though, fall risk should be considered when prescribing a beta-blocker in this age group, and the pros and cons for beta-blockers classes should be taken into consideration.
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Language: en |